Embed Size (px)
Citation preview
2018
At the end of this learning activity, participants will be able to describe:
1. Which member of an EMS service helps ensure
long term service survival?
2. What are the two things an EMS Medical
Director must do to support their service?
3. What is the most important operational
concern for the EMS Medical Director?
Q. WHAT is the KEY FACTOR TO SURVIVAL of small EMS Services in Rural Minnesota:
A. Sense of Duty to Community
B. The Medical Director
C. Want to drive with Lights & Siren
D. Desire to know more about your neighbors
personal lives
Q. WHAT is the KEY FACTOR TO SURVIVAL of small EMS Services in Rural Minnesota:
A. Sense of Duty to CommunityB. The Medical DirectorC. Want to drive with Lights & SirenD. Desire to know more about your neighbors
personal lives
EMSRB Rural Assessment Study 2004
EMSRB Website:https://mn.gov/boards/emsrb/
Minnesota Statute 144E https://www.revisor.mn.gov/?id=144E.265
Details the responsibilities and duties of the medical director
Minnesota Rule 4690https://www.revisor.mn.gov/?id=4690
Describes medication variances, primary service area rules and equipment standards among other things
http://mnemsmd.org/
http://www.naemsp.org/Pages/default.aspx
https://mn.gov/boards/emsrb/
http://www.naemt.org/
National Association of EMS Physicians
www.naemsp.org
NAEMSP EMS Medical Directors Course
Prehospital Emergency Care
PEC Monthly Pod Casts
EMSRB Medical Director Course
EMSRB Physicians.
FEMA Handbook for EMS Medical Directors
Licensed Minnesota Physician
Knowledge of emergency care of ill or injured patients
Familiar with design and operation of Local, Regional, and State EMS Systems.
Willingness to Dedicate your time to your
community and your EMS team .
Education and orientation of personnel;
Standards for equipment and supplies;
Standing orders for pre-hospital care;
Triage, treatment, and transportation guidelines for adult and
pediatric patients;
Quality improvement programs including, but not limited to,
case review and resolution of patient complaints;
Procedures for the administration of drugs;
Maintaining quality of care (encompasses all of the above ).
Educators
Evaluators
Innovators
Collaborators
Motivators
Minnesota Providers: Emergency Medical Responder (EMR ) Emergency Medical Technician (EMT) Advanced EMT (AEMT) Paramedic Community Paramedic
Providers Certification:• Registered or Certified, not licensed• Renew every 2 years
Police/Sheriff/State Patrol
Fire Department/Rescue Squad
Medical Response Unit (MRU)
Basic Life Support Ambulance (BLS)
Advanced Life Support Ambulance (ALS)◦ Part-time Advanced Life Support Ambulance
Community Paramedicine
Specialized Life Support Ambulance• Helicopter
• Fixed Wing Plane
Practical Skills assessment of all EMS personnel yearly (Statutory Requirement)
Designated personnel may do assessment
Records become part of EMS personnel permanent file
Signed off with Medical Director’s originalsignature.
Establish Standard Operating guidelines for Pre-hospital care
Triage, treatment, & transportation protocols◦ Sample Standardized BLS protocols available on the
EMSRB website. https://mn.gov/boards/emsrb/ambulanceservices/ambulanceserviceforms.
◦ EMSC BLS & ACLS pediatric guidelines
◦ Stroke, STEMI, and Trauma System protocols
◦ Special situation protocols
Define method and timing of communications with on-line medical control
Who , What to say, and When to call
Alternate Plan in communication failure:◦ Phone
◦ Text
◦ Radio (Ham)
Transferring Physician responsible for the legal process: (EMTALA)
• Prescribing life support equipment
• Medical treatment
• Possible change in patient condition
Medical Director is responsible :
• Qualified Personnel are required to transport• EMT – RN - Paramedic • Proper Medical Equipment
• Staff handoff at departure & arrival
Address patient transport situations◦ Air transport – Trauma – STEMI – Stroke
◦ Psychiatric/Detox – Special Needs
Based Ono Trauma/Stroke/STEMI protocols
o Patient Needs
o Facility location and designation
o Staffing and vehicles
o Patient condition and stability
o Weather
Nearest appropriate facility if unstable.
Define what types of patients your service can care for: ◦ Transfer/ Intra-facility
◦ BLS
◦ ALS
◦ 911
◦ Air Transport
Work with local ER manager to determine when outside resources will be needed
Experienced 911 Paramedic ◦ Minimum 2 years work experience
◦ Curriculum= 14 credits with 114 didactic hours and 196 clinical hours.
Practice with a EMS Medical Director and Primary Care Provider
Working as CP or combination CP/EMS duties include:◦ Health assessments
◦ Chronic disease monitoring and education
◦ Medication compliance
◦ Immunizations and vaccinations
◦ Laboratory specimen collection
◦ Hospital discharge follow–up care
◦ Minor medical procedures approved by the Ambulance Medical Director
CP Activity shown to ◦ Improve quality of care
◦ Reduce costs
◦ Improve job satisfaction
Medical Assistance covers services provided certified CPs
Minnesota Statute 256B.0625, Subdivision 60 & 144E.28, Subdivision 9
EMS Surge Operation and Crisis Care 2016◦ EMS & MDH joint document
◦ Key point is put plans together in advance
◦ Describes operations in various Scenarios
Conventional
Crisis
Contingency
The more severe the crisis, the greater the risk
Plan in Advance with Local, Regional, and State resources.
EMSRB Website
Event classification matrix – add up scores (0-2) for each of 6 categories:
Higher Risk: total score >=5, or scores of 2 in two different categories.
◦ ALS onsite medical aid station, ALS onsite ambulance and roaming teams are recommended. An onsite physician should be considered,
Intermediate event: Total score 3 or 4, or a score of 2 in any category
◦ BLS onsite medical aid station and onsite ALS ambulance recommended. Staffing levels, number of aid stations and consideration of mobile teams should be based on event characteristics
Lower risk event: Total score <3 and no single category with a score of 2.
◦ BLS onsite care with consideration of onsite BLS ambulance based on event characteristics.
VARIABLE POINTS
2 1 0
Weather
(outdoor events)
>90° F (heat index)
<0° F (wind chill)
No climate controlled shelter
80-90° F (heat index)
0-40° F (wind chill)
Minimal climate controlled shelter
Climate-controlled
environment
Peak Attendance >15,000 1,00-15,000 <1,000
Ethanol Consumption Significant Limited None
Crowd Age Older Mixed Younger
Crowd Intent Animated/Rowdy Intermediate Calm
Transport Time to Hospital >30 minutes 20-29 minutes <20 minutes
State regulatory agency for:
◦ Ambulance Services
◦ EMS Education Programs
◦ EMS Personnel
EMSRB does the following:
EMR Registration
EMS personnel certification
Education Program Certification
EMS Service Licensing
Does NOT make laws, but proposes changes in law
Licensing and Inspection of Ambulance Services to ensure compliance
Investigations of Licensed/Registered/Certified EMS Providers◦ May result in restrictions on ambulance service licenses, education
programs or credentials of EMS personnel.◦ Structure of process is changing.
Credentialing of EMS Personnel
Grants Management
Emergency Management collaboration with State, Regional, and Local partners.
MNSTAR – Minnesota Ambulance Patient Care Reporting System
8 Regional Programs
Provide education and other resources for EMS in region.
http://mn.gov/health-licensing-boards/emsrb/grantprojects/regional-programs/
National Registry of Emergency Medical Technicians
EMT 144 hour class plus ride along and Testing
Paramedic : roughly 2 years of training .
Community PM 16 hours more college level training
EMS providers required to be NREMT’s
National Core Competency Program for recertification ◦ 60 hours required every 2 years
National 30 hr
Local 15 hr
Individual 15 hr
No psychomotor testing
Active MN certified EMT will be allowed in MN till 2030.
Medical Director for BLS Service may request variance to allow administration of certain medications:◦ Sublingual nitroglycerin ◦ Epinephrine pen injector◦ Beta agonist (nebs and metered dose inhalation)◦ Glucagon
No variance required for non prescription medicines, (aspirin, Benadryl) but Medical Director gives order.
Naloxone: does not require a variance, but does require Medical Director approval/education/protocol
Medical Director is responsible for annual education◦ This can be delegated to staff and ideally should be done collaboratively◦ It is a high yield time to connect with staff
Medical Director may also allow personnel with appropriate education to:◦ Initiate/maintain IV infusion
◦ Use Supraglottic Airway
◦ CPAP
◦ Other reasonable interventions
EMSC Minnesota:
Federal & State collaborative initiative
Federal Grants help improve care
EMSRB & Children’s Minnesota collaborative
Programs
Research in medical and trauma care
Grants
Hands on Training
See EMSRB Website
Reviews & approves requests for ambulance service variances.
Resource regarding medical protocols:◦ EMSRB staff
◦ Ambulance services
◦ Medical directors
Cooperative position including all physicians on the EMSRB
Proposes changes in rules/statutes to the Board regarding medical practice on ambulances
Provides model medical protocols for Medical Directorshttps://mngov/boards/emsrb/ambulanceservices/ambulanceserviceforms
Resource to the Board and Ambulance Services regarding care issues.
We are always interested in your point of view
Qualifications to be on this committee?
Any EMS Medical Director who is willing to participate.
Most important Medical Director job.
It’s not enough to know it when you see it.
Formal process must be established with Medical Director involvement under the Peer Review statute 145.64.
The QA loop must be complete!
Protocols
Education &
Training
Run
Analysis vs.
Protocols
Determine
Variance
Find cause
for variance
Resolve
Problem
Discipline
https://www.colorado.gov/pacific/sites/default/files/EMTS_Medical-Directors-Continuous-Quality-Improvement-Program-including-protocols.pdf
Special Situations for the Service:
May need review through the QA Process
Refusal of care Pediatric patients
Terminally ill patients Physicians on scene
Non-transports Incompetent patients
YOUR Trauma Hospital is DECERTIFIED!
EMSRB not responsible!
We are ready to give you help & guidance
Team up with your Ambulance Service Manager and Education Program Coordinator.
Know what the service/program needs are.
Understand the economics of providing quality ambulance service and education.
Use Adult education methods.◦ https://generalassemb.ly/blog/principles-teaching-adults/
Give run reviews priority.
Take a long-term view of service/education development and changes.
Develop “structure” to support the service’s “function.”
Pay attention to “group dynamics” and help out when needed.
Respect and nurture EMT’s - especially volunteers.
Be careful of YOUR time & energy input: avoid personal burnout.
ALWAYS SIGN THE EMSRB / NREMT PAPERWORK QUICKLY (plan ahead for deadlines- end of march)
144E.103 EQUIPMENT. Subdivision 1.General requirements. Every ambulance in service for patient care shall carry, at a minimum: (1) oxygen; (2) airway maintenance equipment in various sizes to accommodate all
age groups; (3) splinting equipment in various sizes to accommodate all age groups; (4) dressings, bandages, commercially manufactured tourniquets, and
bandaging equipment; (5) an emergency obstetric kit; (6) equipment to determine vital signs in various sizes to accommodate
all age groups; (7) a stretcher; (8) a defibrillator; and (9) a fire extinguisher.
Subd. 2.Advanced life-support requirements.
ALS ambulance must carry drugs, drug administration
equipment ,and supplies as approved by the licensee's medical director
Subd. 2a.Maintenance, sanitation, and testing of equipment, supplies, and drugs.
Subd. 3.Storage
Subd. 4.Safety restraints
Subd. 5.Communication equipment.
Long Shifts
Working at night
Working other jobs
Drug abuse ?
PTSD
FATIGUE IN EMS . Sponsored by Nat. Assoc. of State EMS Officials
1.Reliable Fatigue and sleepiness assessment used to evaluate
fatigue
2. Shifts shorter than 24 hrs.
3. Access to caffeine
4 Opportunity to Nap at work to mitigate fatigue.
5. Fatigue risk and mitigation training
Name the position in a EMS squad, who helps ensure long term squad survival.
Dedicated Medical Director
If you are short on time; name two things you must do for the
squad?
QA Run Review Activity
Sign the EMSRB/NREMT paperwork
What is your most important operational concern?
SAFTEY!
EMSRB Tony Spector EMSRB Director
Aaron Burnett MD State Medical Director
Jeffrey Ho MD [email protected]
Paula Kocken MD [email protected]
John Pate MD [email protected]
MDSAC Peter Tanghe MD [email protected]
